Is it OK to flush prescription meds?

Pharmaceuticals and personal care products are detectable in almost all water systems.

I have two questions: 1. What should I be doing with old pharmaceuticals? And what do the pharmacies/pharm companies do with them? 2. Should I avoid all anti-microbial products?

— Lewis Perkins

Dear Lewis,

Thanks for the questions. I’ll get to the second one — about anti-bacterial/microbial products — in, uh, soon. First question first:

Although reports of Prozac in our drinking water are sometimes dismissed as urban myth, by now most folks know that pharmaceuticals and personal care products (PPCPs, as the Environmental Protection Agency refers to them) are, indeed, detectable in almost all water systems.

PPCPs get into drinking water in several ways: individuals, hospitals and nursing homes or hospices flush unused or expired medication down sinks and toilets; waste from pharmaceutical manufacturing ends up in municipal wastewater; and portions of the products consumed are unabsorbed by the body and passed in the urine and feces of both humans and animals.

This haphazard disposal of PPCPs (both over-the-counter and prescription) is an increasingly serious problem as we become an increasingly medicated country. Prescription drug sales rose by an annual average of 11 percent between 2000 and 2005. Americans now fill more than three billion prescriptions a year; nationwide, more than 10 million women take birth-control pills, and about the same number are on hormone-replacement therapy.

Testing for pharmaceuticals in U.S. waterways is a relatively new science. In 2002, the United States Geological Service (USGS) found traces of 82 different contaminants including natural and synthetic hormones, antibiotics, antihypertensives, painkillers and antidepressants in our water. According to the Environmental Protection Agency (EPA), those metabolites are virtually everywhere: water facilities of both urban and rural areas, groundwater, mountain streams, surface water and domestic wells.

While levels of pharmaceuticals are sometimes infinitesimally low, our exposure is constant as their presence is continually being replenished. And research suggests that the mixture of different substances may be a bigger issue than the quantity. (Researchers are finding that mixtures of chemicals can lead to effects at much lower levels than do single chemicals, and that low-level exposure can often induce results not seen at higher levels). We can’t yet prove the exact risks from continuous exposure to combinations of pharmaceuticals on humans, but recent studies have found alarming effects on human cells and wildlife. Studies have linked hormone exposure to reproductive defects in fish and environmental exposure to antibiotics to the development of drug-resistant germs.

Definitive research aside, I find the idea of my growing son exposed to the aftermath of 20 million hormone-based prescriptions, well … alarming. Male fish are developing ovaries, or not developing at all. In some species, females now outnumber males 5 to 1. Genital abnormalities are now the most common birth defects in American baby boys — a fact certainly related to hormone disrupters in plastics and likely exaggerated by exposure to hormones in the water supply. Fish and amphibians have become our canaries in the coal mine; we are our own lab rats.

• On an individual level, use a filter that specifically removes pharmaceuticals. The one I know of, Aquasana, can be found here. (I'm sure there are others, too.) Other negatives of bottled water aside — manufacturing, transportation, fossil fuel content, cost, solid waste, plastic-related health issues — remember that bottled water is frequently nothing more than tap water in a bottle and actually has lower regulation standards than tap water.

• Write to your senator and congressperson to demand regulations and oversight of our water supply. Information can be found at the Environmental Working Group’s Take Action page. Call on pharmaceutical companies to follow responsible business practices by implementing collection and disposal programs of PPCPs, or financially supporting those programs.

• Limit the amount of drugs that you take or purchase in the first place. For your own health and the planet’s, don’t take anything you don’t really need. Buy only as much as you’re likely to use before the expiration date (don’t, for example, buy aspirin in bulk to save a buck). And if you start a new medication, ask the doctor to prescribe only enough to see if the medication will work for you. That way, if the medication doesn't suit you, less is wasted.

And how to dispose of what you do end up with?

• Don’t flush PPCPs, whether in the form of a liquid or a solid. The EPA has deemed flushing PPCPs in domestic sewage systems as the "least desirable way to dispose of any drug." Wastewater treatment plants and septic systems are not currently designed to treat pharmaceutical waste.

• Instead, check with your police department to see if they have a drug collection program. Some city police departments and county sherriff’s offices have established disposal programs; if yours hasn’t, ask them to.

• Check to see if your community household hazardous waste program collects medications. Most communities have pharmaceutical take-backs at least once a year that allow the public to bring unused drugs to a central location for disposal. These are often part of EPA-sponsored household hazardous waste collection efforts. Earth911 is my go-to place for recycling resources. Enter your ZIP code for local information. Occasionally, you’ll find a pharmacy that is willing to take waste PPCPs — ask your pharmacist.

• Take unused or expired prescription drugs out of their original containers (remove labels or blackout prescription and personal information).

• Mix prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and put them in impermeable, non-descript containers (empty cans or sealable bags) to ensure the drugs are not diverted — for illicit use, or accidentally ingested by animals or children. Watch this video for one such disposal technique.

• These options should be followed for both over-the-counter and prescription meds, whether yours or your pet’s!

As to your question about what pharmacies and pharmaceutical companies do with their excess or expired drugs, it's hard to say. Nursing homes and hospices, which may have even greater amounts of waste PPCPs than pharmacies, are free to flush them. Pharmacies also dispose of some waste in the trash or sewer, and coordinate with the EPA and law enforcement, or a “reverse distribution” company to dispose of hazardous waste. These reverse distribution companies return eligible, expired drugs to the manufacturers for credit. But disposal is complicated by unclear, and outdated definitions of what is considered hazardous, and conflicts between state and federal requirements. Indeed, it is not unusual for pharmacies to discard controlled substances and antibiotics through the sewer system. Products that are collected — from pharmacies, institutions or individuals — are usually incinerated. CNN Money explored this issue, focusing on Illinois-based Stericycle and New Jersey’s Covanta which sell expired drugs to utility companies that incinerate the waste as part of their energy-generating process.